CORRELATION BETWEEN GRACE RISK SCORE AND CARDIOVASCULAR EVENT RATE IN PATIENTS WITH ST SEGMENT ELEVATION MYOCARDIAL INFARCTION WITH SUCCESSFUL FIBRINOLYSIS AND DELAYED CORONARY INTERVENTION

Background: In several countries, Fibrinolytic therapy represents the main reperfusion therapy for most STEMI patients due to limitation of PCI-capable hospitals. Current practice guidelines recommended routine early pharmacoinvasive (within 2?24 h) after successful fibrinolysis, however, it cannot be performed in timely fashion due to limitation of PCI-capable hospitals. Aim of the work: to evaluate the prognostic utility of the GRACE risk score in patients receiving delayed intervention after successful fibrinolysis in non PCI-capable hospitals. Methods: This was a prospective cross sectional observation study that was conducted from March 2017 to February 2018 and included 120 patients presented to the coronary care unit at AL-Azhar University Hospital and Al Mataryia Teaching Hospital with acute STEMI and treated successfully with thrombolytic therapy. All patients were subjected to complete clinical assessment, serial ECGs, Echocardiography, full labs. The STEMI patients who had successfully fibrinolysis and received delayed PCI (during 24h to 14 days) were included. Follow up was done on outpatient basis monthly after delayed PCI for three months. Results: There were 70 patients (58.3%) with low GRACE score and 50 patients (41.7%) with high GRACE score. This study shows that more than three quarters of the studied cases had no follow up complications and the most frequent complication was ACS. The percentage of cases which had ACS was 13.3% (number of patients 16), the percentage of cases with HF was 9.2% ( number of patients 11), the percentage of cases with stroke was 1.7% ( 2 patients ) and only one case died. During 3 months, the cardiovascular complications occurred in 8 patients in low GRACE group and 20 patients in high GRACE group (P <0.001). Cases with cardiovascular complications had significantly higher time from successful fibrinolysis to PCI (P <0.001). Conclusion: The long delay pharmacoinvasive strategy in intermediate to high GRACE score after successful fibrinolysis in non PCI-capable facilities was associated with worse cardiovascular outcomes (death, re hospitalized with ACS, re-hospitalized with HF and stroke) than the patients with low GRACE score within 3 months.